Post-Tonsillectomy and Adenoidectomy Bleeding Emergencies

​I have immense respect for a few pediatric emergency conditions. Post-surgical bleeding following a tonsillectomy and adenoidectomy (T&A) has given me several memorable patient care experiences over the years. Honestly, the word "memorable" is actually a euphemism for terrifying.​Part of the problem with post-T&A bleeding is the patient. Typically, it's a pediatric patient who for hours has been quietly bleeding into the posterior pharynx while quietly swallowing the evidence (e.g., blood). By the time the patient presents to the ED, a significant but unknown percentage of the child's total blood volume has been lost. We cannot begin to guess how much blood has actually been lost until the patient starts vomiting. Suddenly realizing that your pediatric patient is already in compensated shock is a frightening experience.The problem with T&A surgery is that bleeding can come from four locations. Two adenoids and two tonsils are removed. The bleeding can occur immediately after the surgery or, more commonly, days to weeks later. Bleeding can occur in the nose and the mouth, and these are not easily accessible for applying direct pressure to stop the bleeding.My most recent patient was a 5-year-old who presented with a nosebleed three weeks after her tonsillectomy and adenoid surgery. The nosebleed had already been going on for three hours by that time. Her mother had already applied oxymetazoline, an adrenergic receptor agonist, eight to 10 times her n...
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